Different Pain Management Strategies – Brain Maps

The first part in the upper left corner of the pain block is PHYSICAL INTENSITY. This is that 0-10 rating of how LOUD the pain signal is. This is what we are usually aiming to reduce to when we try new medications or other treatments.

The second part in the upper right corner of the pain block is the AGONY of pain. Pain is one of the class of sensations that when it hits the brain, also activates other parts of the brain that create emotional responses. Pain is not alone in this ability to activate more than just sensation. Think of the agitation that is elicited by an itch, or the panic when you catch your breath, or the pleasure of sensual touch. Pain activates the emotional pathway of agony, it is an intense bothersomeness. Interestingly, as you will learn, pain does not have to activate this agony pathway all the time – we just have to teach our brains how to change it.


The third part in the lower right hand corner of the pain block is IMPACT. The Impact of pain is all the ways that pain affects our lives. The impact in our lives is far reaching including our sleep, energy, stamina, movement, social life, our ability to work the way we used to, our costs of living, memory, mood, and even our sense of who we are as a person.


The fourth part of pain in the lower left hand corner of the pain block is NEGATIVE STIGMA. Stigma is pervasive in our society. The bias against individuals is very real and destructive.

The most important thing about the MPM program is that it is highly systematic and based on the scientific method. As a chronic pain sufferer I know that I have tried many different approaches to mitigate or deal with my pain. I tried pain killers, physiotherapy, exercise, anti-inflammatory drugs, sleep aids, music… even sex and other intense emotional and physical interactions to try to drown out the noise of pain. None of them make the pain go away, but sometimes I have felt some amelioration of the pain. For me the most consistently successful of these strategies has been distraction from the experience of pain by focussing my attentions on some other thing, usually an interaction with another person, or sometimes a creative visualization of an intense subject.

The key to the method taught in my course, however, is not the specific technique itself that worked, or didn’t work, but he careful examination of various approaches using the scientific method, to test a number of potentially helpful strategies, in an orderly manner. Those that seem most promising are then examined in the context of the other methods, with the eventual idea that some of these may be even more effective if combined together.

Interesting enough, the very fact of dispassionately examining what has worked in the past in an organized fashion itself helps to ameliorate some of the pain by lessening my fear that it will continue to be out of my control altogether. No matter how sever the pain seems at any given moment, it is made far worse by my imagining that it will only ever get worse, and the fear itself tends to increase my awareness and sensitivity to my pain. Analysis actually substantive reduces the experience of pain but bringing it into the realm of personal control. Believing that I can control the pain, to any significant degree, actually helps me control the pain, to a degree.

Here is a sneak peak at what is in store for me as I follow the Mastering Pain Management training program.

Activate Endogenous Opioids – Ever wish you could feel that “high” that runners talk about, but know you aren’t about to go run 12 miles? That high is from our body’s own opioid system and it doesn’t require running to trigger it. In fact, there are a number of ways to turn to the system on. The biological evidence shows that we can do this on your own in just a few minutes. While some of the skills might involve imagination, the effect is not imaginary, the opioids are real, the response is real, and the science to demonstrate the process is real. These are some of the most powerful IMMEDIATE RELIEF skills of the Mastering Pain Method. In person, we have witnessed an average of a 50% drop in pain intensity. Its now your turn to discover how well the skills work for you.

Retrain Sensory and Motor Nerves – Learn how to have mastery over out-of-control sensory nerves and motor nerves that are keeping muscles guarded and tight or sending signals to the brain that aren’t helpful.

Rewire Agony/Suffering Circuitry – Change the patterns in your brain that make pain so unbearable. Clear cut evidence exists showing that we can change the way our brains respond to pain and only experience it as a sensation without all the agony and suffering that is usually associated with it.

Train Vagal Tone/Relaxation Response – Pain is so overwhelming and activates our danger sensors leading to adrenaline bursts from the fight or flight response. To calm this response we can train a special system, the Relaxation Response, that is associated with the Vagus Nerve.

Engage Pleasure Circuitry – Change the patterns in your brain that make pain so unbearable. Clear cut evidence exists showing that we can change the way our brains respond to pain and only experience it as a sensation without all the agony and suffering that is usually associated with it.

Engage Restorative/Anti-Inflammatory Systems – Our body produces inflammation when stressed. And the body is clearly stressed by pain. Regardless of the cause of the pain learning how to put a stop to the inflammation is critical – even more so when the cause of the pain is an inflammatory condition. Our bodies’ are amazing full of ifferent ways to stop and start inflammation. Learning to turn off inflammation and turn on the restorative systems.

Retrain Interpersonal Neurobiology – Our body responds when we interact with others. It has certain patterns of responses to different environmental cues. These patterns impact our sense of self and our relationships. Learn how retraining these
skills can improve pain and begin the trend to change the cultural stigma of chronic pain.

From MPM Chapter 3

It often seems highly hypothetical to consider that pain may be somewhat controllable by following a road map of different strategies in an organized and systematic manner. My sincerest hope is that the program is right, and I can learn to have a much higher level of control than I have at the present time. Many years ago I took a training course in personal development which taught me that “understanding is the booby prize” by which the trainers meant that it is in doing something rather than in understanding something that lies the potential for real change in human experience. However, without the “booby prize” of understanding the nature of pain, and systematically examining what works and doesn’t for me, I am highly unlikely to accidently come upon actions which will have any significant effect over the long run, or even have any real impact on a moment by moment basis.

Pushing on

Past the pain

It is Friday afternoon, and I’m sitting at my desk thinking about the past week. Wow! What a week it has been, and despite everything I’ve kept to my Intermittent Fast.

It has been a struggle, not to keep up with my fast, but to keep my blood glucose in tight control. I try to maintain my readings in a range between 4 and 7.8 mml, from my Free Libra meter. Twice in the past week my readings have been wayyyyy too high, up as high as 15 mml for a few hours after a meal, and even as high as 10mml all day long on my fasting days. Ouch! But I need to explain that in order to keep my levels in the right zone, it isn’t as simple as it seems.

I have to control not only my food intake, which I’m managing by eating low carb healthy meals on my eating days, without being obsessive about it, and fasting my three days a week, but also adjusting my insulin and other medications to balance off my fasting and feasting.

Photo by freestocks.org on Pexels.com

This week, for the first time, I haven’t been taking my jentadueto which up until I’ve been taking twice a day, once in the morning and once at dinner time, even though I’ve been skipping on my fasting days. This week I’ve stopped taking them altogether, largely as a result of concerns about chronic pain, which seems to have become much worse since I switched from pure metformin a couple of years ago. My pain this week has been terrible, and I’ve thrashing about trying to figure out what’s triggering it.

Metformin itself can cause chronic pain, either as a standalone drug or as a component in Jentadueto.

I probably should have increased my insulin even more than I did, both on my fasting days and my eating days. As an adjustment for not taking the metformin I increased by long acting insulin to 35 g from 30 on my fasting night, and 40 to 45 g on my eating days. On both days my blood glucose levels were high all day, above 8mml but even higher, up to 15mml.

Tonight I’ll increase my insulin long acting to 50 units, and see if that does the trick, along with controlling my carbs. I’ll get it right, sooner or later.

Christopher Columbus – This week I played Christopher Columbus in a short movie.

However, what made me say “Wow” to my week is that this is the first time in my life I’ve actually been a paid actor in a documentary tv series. I don’t know if my scene will end up on the cutting room floor, although I hope not, but in some way it doesn’t matter. I’m now officially an “actor” because someone has paid me to appear in a movie or tv show.

One of the things I’m determined to do is to try new experiences, and to expand my capacities. Having shot one show suggests that I can do more, if I want. And I think I do. It’s important for me to make some money, of course, since I don’t think anybody can live on their Canada Pension Plan and Old Age Security checks. But I don’t need to make a lot of money, just enough to take the edge off, and be able to afford the luxuries of life, like food and housing.

Me as Christopher Columbus in a film shot in Vancouver, BC this week.

The fact that my acting debut happened the same week as my excruciating pain, and all my adjusting of my meds is perfect. Fasting doesn’t interfere with life, it is simply just another part of life. Pain interferes with life, for sure, but I won’t allow it to stop me from doing something fun and interesting.

Fibromyalgia and Diabetes

Does insulin resistance cause fibromyalgia?

A newly confirmed link with insulin resistance may radically change the way fibromyalgia and related forms of chronic pain are identified and managed

Date:May 7, 2019 Source:University of Texas Medical Branch at Galveston Summary:Researchers were able to dramatically reduce the pain of fibromyalgia patients with medication that targeted insulin resistance.

I have not been diagnosed with fibromyalgia, at least not yet. However, the development of chronic pain has paralleled my diabetes over the past twenty-five years. For most of these years I have taken metformin or other compounds including metformin, which may have been providing some mitigation of the numerous forms of pain I have battled with over the years.

So, in addition to the pain potentially caused by “dysfunction within the brain’s small blood vessels” caused by insulin resistance, as noted in the report on this study, I think researchers should also study the link between inflammatory diseases and diabetes, to determine any causality, either way. 

Having had a lifetime of inflammatory issues, starting with chronic allergies to a multiplicity of substances, arthritis, tendonitis, asthma among other painful inflammatory symptoms have laid the groundwork for neuropathy and muscular inflammation. The pain in my feet and hands has nearly become disabling from a combination of pain from neuropathy, arthritis and tendonitis.

In the meantime, my medical practitioners have their hands full trying their best to assist me in dealing with the symptoms, as well as with the underlying issues related to diabetes. My muscle and skeletal pain issues are largely untreated while I struggle with diabetes, as an insulin dependant diabetic. 

From this report, among other studies I’ve read, it is clear that there is little that can be done to reduce my experience of chronic pain that does not also improve my A1C levels on an ongoing basis.

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Three things need to change in order for there to be a significant reduction in both – a substantial reduction in my current weight, exacerbated by using insulin, better A1C blood sugar management, which may be a result of changing the form and administration of insulin to a much more intense dose management more closely related to my blood sugar levels and meal times, and a more appropriate combination of reduced caloric intake with a physical exercise regime which focuses as much on increasing flexibility of my skeletal and muscular systems, as on weight loss or caloric output. 

I think, from my own experience, that the cited report offers some valuable clues to fibromialgia, its causes and some potential treatments. But I also think that these relationships are more complicated that they appear on the surface, and may require much more than a magic bullet to help deal with the pain.